ABSTRACT
Carbon dioxide (CO) embolism is a complication of laparoscopic surgery that, although often does not have adverse sequelae, can be fatal. This is due to the fact that when CO is injected into the blood vessels, the bubbles impede blood flow, which clinically expresses as: decreased stroke volume, hypoxemia, sudden fall or sudden increase in expired CO, bradycardia, hypotension, dyspnea, cyanosis, arrhythmias, bilateral mydriasis, murmur in a mill wheel at auscultation and cardiovascular collapse with cardiorespiratory arrest. In this article we will present physiology of venous embolism, diagnosis, syntoms, treatment and prevention.
La embolia por dióxido de carbono (CO) es una complicación de la cirugía laparoscópica que, aunque a menudo no presenta secuelas adversas, puede ser fatal. Esto se debe a que al inyectar CO en los vasos sanguíneos las burbujas impiden el flujo de sangre, lo que clínicamente se expresa como: disminución del volumen sistólico, hipoxemia, caída repentina o aumento súbito del CO espirado, bradicardia, hipotensión, disnea, cianosis, arritmias, midriasis bilateral, soplo en rueda de molino a la auscultación y al colapso cardiovascular con paro cardiorrespiratorio. En este trabajo presentaremos fisiología del embolismo venoso, cuadro clínico, diagnóstico, tratamiento y formas de prevenir que ocurra este evento.
Subject(s)
Humans , Carbon Dioxide/adverse effects , Laparoscopy/adverse effects , Embolism, Air/etiology , Risk Factors , Embolism, Air/diagnosis , Embolism, Air/therapyABSTRACT
La presencia de gas portal intrahepático en adultos es un fenómeno multifactorial en el que se comparten factores inflamatorios y protrombóticos sistémicos, frecuente en pacientes con cirrosis hepática avanzada y raro en individuos con hígado sano, sin embargo la presencia de focos inflamatorios abdominales y estados de hipercoagulabilidad secundaria a la respuesta inflamatoria sistémica la hace más frecuente, sus manifestaciones son inespecíficas y variables según la gravedad del cuadro. Presentamos dos pacientes con sintomatología inespecífica y estudios imagenológicos que reportaron gas portal intrahepático, uno secundario a enfermedad diverticular y otro a abscesos hepáticos que evolucionaron favorablemente con tratamiento quirúrgico, antibiótico y anticoagulante.
The presence in adults of intrahepatic portal gas is a multifactorial event in which systemic inflammatory and prothrombotic factors coexist, it is common in patients with advanced liver cirrhosis and rare in those with a healthy liver, however its frequency increases with the presence of inflammatory abdominal disorders and hypercoagulability related to systemic inflammatory response, their manifestations are unspecific and varies according to severity. We study two cases with unspecific symptoms, where imaging studies reported intrahepatic portal gas, one secondary to diverticular disease and the second related to liver abscesses, which favorably response with surgical, antibiotic and anticoagulant treatment.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Embolism, Air/diagnosis , Liver Diseases/diagnosis , Portal Vein , Venous Thrombosis/diagnosis , Acute Disease , GasesABSTRACT
Clinically significant carbon dioxide embolism is a rare but potentially fatal complication of anesthesia administered during laparoscopic surgery. Its most common cause is inadvertent injection of carbon dioxide into a large vein, artery or solid organ. This error usually occurs during or shortly after insufflation of carbon dioxide into the body cavity, but may result from direct intravascular insufflation of carbon dioxide during surgery. Clinical presentation of carbon dioxide embolism ranges from asymptomatic to neurologic injury, cardiovascular collapse or even death, which is dependent on the rate and volume of carbon dioxide entrapment and the patient's condition. We reviewed extensive literature regarding carbon dioxide embolism in detail and set out to describe the complication from background to treatment. We hope that the present work will improve our understanding of carbon dioxide embolism during laparoscopic surgery.
Subject(s)
Humans , Carbon Dioxide/adverse effects , Embolism, Air/diagnosis , Insufflation/adverse effects , Laparoscopy/adverse effectsABSTRACT
Venous air embolism (VAE) is the entrapment of air or medical gases into the venous system causing symptoms and signs of pulmonary vessel obstruction. The incidence of VAE during cesarean delivery ranges from 10 to 97% depending on surgical position or diagnostic tools, with a potential for life-threatening events. We reviewed extensive literatures regarding VAE in detail and herein described VAE during surgery including cesarean delivery from background and history to treatment and prevention. It is intended that present work will improve the understanding of VAE during surgery.
Subject(s)
Female , Humans , Pregnancy , Anesthesia, Obstetrical/adverse effects , Cesarean Section/adverse effects , Echocardiography, Transesophageal/methods , Embolism, Air/diagnosis , Intraoperative Complications/diagnostic imaging , Monitoring, Intraoperative/methods , Obstetrics/methods , Risk Factors , Ultrasonography, Doppler/methodsABSTRACT
Crohn's disease is characterized by its chronic course and transmural inflammation of gastrointestinal tract. The accompanying fibrous reaction and adhesion to adjacent viscera appears to limit the complication of free perforation. The true incidence of free bowel perforation is difficult to assess, however, the anticipated occurrence rate is 1-2% during the course of illness. Moreover, portal venous gas is also an uncommon event in the natural history of Crohn's disease. Portal venous gas occurs when intraluminal gas from the gastrointestinal tract or gas-forming bacteria enters the portal venous circulation. The finding of portal venous gas associated with Crohn's disease does not always mandate surgical intervention. We experienced a case of Crohn's disease presenting with free perforation and portal venous gas. The literatures on the cases with perforation and portal venous gas associated with Crohn's disease were reviewed.
Subject(s)
Adult , Humans , Male , Colonoscopy , Crohn Disease/complications , Diagnosis, Differential , Embolism, Air/diagnosis , Intestinal Perforation/diagnosis , Portal Vein , Tomography, X-Ray ComputedABSTRACT
Ischemic stroke due to embolic air is uncommon. There are few reports of patients with air embolic stroke as a complication of endoscopic procedures. The temporal relationship between the stroke and this procedure is the most important clue for the diagnosis. CT scan and MRI of the brain are confirmatory tests. The morbidity and mortality is high. Patients should be hospitalized in a critical care service and treated as soon as possible with oxygen in a pressure camera. We report a 52 years old woman with an ovarian cancer that, during an upper gastrointestinal endoscopy, had a severe alteration of consciousness that did not respond to the use of Flumazenil. A CT scan showed multiple areas of air embolism in the watershed area between anterior and middle right cerebral arteries. A conservative treatment was decided and the patients died 48 hours later.
Subject(s)
Middle Aged , Embolism, Air/diagnosis , Embolism, Air/etiology , Endoscopy, Gastrointestinal/adverse effects , Middle Cerebral Artery , Fatal OutcomeABSTRACT
JUSTIFICATIVA E OBJETIVOS: A embolia venosa por CO2 durante cirurgias laparoscópicas é uma complicação rara, porém fatal na maioria dos casos. O objetivo deste relato é descrever um caso não fatal de embolia venosa por CO2 durante cirurgia laparoscópica. RELATO DO CASO: Paciente hipertensa foi submetida à anestesia geral para laparoscopia para exploração de colédoco. Após 150 minutos de pneumoperitôneo, a paciente evoluiu com taquicardia e hipotensão refratária ao uso de vasopressor. A gasometria arterial revelou grande diferença entre a pCO2 e a P ET CO2. Frente à hipótese de embolia gasosa, foi desinsuflado o pneumoperitôneo, e a cirurgia terminada pela técnica convencional. A paciente evoluiu com melhora do quadro hemodinâmico, sendo extubada ao término da cirurgia e encaminhada para sala de recuperação pós-anestésica (SRPA). CONCLUSÕES: O diagnóstico precoce e o tratamento imediato foram fundamentais na boa evolução do caso descrito.
Subject(s)
Female , Aged , Humans , Carbon Dioxide , Cholecystectomy, Laparoscopic , Embolism, Air/diagnosis , Embolism, Air/etiology , Intraoperative Complications , Insufflation/adverse effectsABSTRACT
JUSTIFICATIVA E OBJETIVOS: A embolia aérea arterial é uma complicaçäo que pode ocorrer durante diversos tipos de procedimentos cirúrgicos e está relacionada à alta incidência de morbidade e mortalidade. O objetivo deste relato é mostrar um caso de embolia aérea arterial durante anestesia geral para marcaçäo percutânea de nódulo pulmonar guiada por tomografia computadorizada. RELATO DO CASO: Paciente de 33 anos, do sexo masculino, estado físico ASA II, foi submetido à marcaçäo percutânea de nódulo pulmonar (provável metástase de tumor de células gigantes do fêmur) com agulha gancho, sob anestesia geral. A induçäo anestésica foi realizada sem dificuldades e com o paciente em decúbito lateral direito, o procedimento foi iniciado. Após a instalaçäo do gancho, enquanto os cirurgiöes verificavam seu posicionamento com novas imagens de tomografia, foram observadas hipotensäo arterial e bradicardia, seguidas de assistolia. Foram realizadas manobras de reanimaçäo, drenagem torácica e ecocardiografia transtorácica. Em um dos cortes tomográficos mais recentes foi visualizada presença de ar no interior da aorta descendente. Após 15 minutos de reanimaçäo houve reversäo do quadro. O paciente foi encaminhado à UTI e 6 dias após recebeu alta hospitalar sem seqüelas. CONCLUSÕES: A embolia aérea arterial é uma complicaçäo de vários procedimentos e na maioria deles o paciente está sob anestesia geral. O anestesiologista deve estar preparado para reconhecer as alterações envolvidas e fazer o diagnóstico diferencial. A instituiçäo de medidas terapêuticas oportunas e adequadas säo fundamentais para a reduçäo da morbidade e da mortalidade decorrentes deste evento
Subject(s)
Humans , Male , Adult , Anesthesia, General , Aorta, Thoracic/injuries , Biopsy, Needle/adverse effects , Embolism, Air/diagnosis , Embolism, Air/etiology , Lung/pathology , Tomography, X-Ray ComputedABSTRACT
El embolismo aéreo venoso (EAV) es una complicación frecuente en cirugía, que puede presentarse en cualquier caso que sea abierta una vena. Produce severos cambios hemodinámicos e incluso puede producir la muerte. En forma concreta, la neurocirugía propicia el EAV en vista de que mecánicamente se favorece por circunstancias tales como: elevados gradientes gravitacionales, PVC baja y posiciones extremas como la de sentado o la de Trendelenburg invertida. En este estudio, con el objeto de detectar oportunamente EAV, se monitorizaron 37 pacientes en el transoperatorio mediante ecocardiografía trans-esofágica durante su acto neuroquirúrgico, además del monitoreo habitual como presión arterial, PVC, electrocardiograma, capnografía y oximetría de pulso. Se presentaron 41 episodios de EAV en 21 de los 37 pacientes (56.7 por ciento), sin embargo sólo 12 tuvieron cambios en la capnografía y sólo 3 de los 21 (14.2 por ciento) tuvieron cambios hemodinámicos. Se concluye que el diagnóstico oportuno de esta contingencia permitió en todos los casos aplicar tempranamente el tratamiento indicado.
Subject(s)
Humans , Male , Female , Postoperative Complications/etiology , Postoperative Complications/physiopathology , Embolism, Air/diagnosis , Neurosurgical Procedures/adverse effects , Echocardiography, Transesophageal , Blood PressureABSTRACT
Os autores relatam caso de embolia aérea cerebral maciça após grave traumatismo torácico e cérvico-craniano, em adulto jovem, que sofreu acidente automobilístico. A tomografia computadorizada do crânio e da coluna cervical mostrou grande quantidade de ar no sistema carotídeo intra e extracraniano e no sistema vértebro-basilar, dando ao quadro o aspecto de "angiografia gasosa cerebral".
Subject(s)
Adolescent , Male , Humans , Embolism, Air/diagnosis , Intracranial Embolism , Trauma, Nervous System , Trauma, Nervous System/diagnosis , Tomography, X-Ray ComputedABSTRACT
La cateterización venosa central está indicada cuando no es posible canular venas periféricas, hay necesidad de infundir soluciones irritantes o nutrición parenteral, o se requiere monitorización hemodinámica. La vena basílica permite una fácil punción pero es difícil llegar al tórax, y las tasas de infección y de trombosis son altas. La vena subclavia es fácil de puncionar, pero presenta riesgo de neumotórax y de punción arterial. La vena yugular interna puede ser puncionada en su trayecto bajo el músculo estemocleidomastoídeo, y aunque el riego de neumotórax es mínimo, el de punción arterial es mayor. La vena yugular externa es la vía de elección en pacientes con coagulopatías, pero resulta difícil introducir un catéter hasta el tórax. La vena femoral es la vía de elección en resucitación cardiopulmonar, aunque presenta alta tasa de trombosis. Las complicaciones de la cateterización venosa deben ser reconocidas oportunamente. La técnica de Seldinger es preferible para minimizar la hemorragia en el sitio de inserción. La embolia área se previene con un adecuado manejo de las presiones intratorácicas. El neumotórax y la mal posición del catéter deben ser buscados sitemáticamente mediante radiología. La infección generalmente refleja diserminación de gérmenes a partir de otros focos y en la mayoría de los casos basta recambiar el catéter sobre una guía metálica
Subject(s)
Humans , Catheterization, Central Venous , Infusions, Intravenous , Catheters, Indwelling/microbiology , Embolism, Air/diagnosis , Embolism, Air/prevention & control , Hydrodynamics , Pneumothorax/diagnosis , Pneumothorax/physiopathology , Subclavian Vein/surgeryABSTRACT
Desde el punto de vista anatómico ninguna región del cuerpo humano concentra en un volumen relativamente pequeño tantas estructuras vitales como el cuello. De ahí que cualquier intervención quirúrgica cerviacal conlleva riesgos de yatrogenia o de complicaciones no esperadas mayores que cualquiera otro tipo de procedimiento operatorio. Esta exelente revisión resume la experiencia del autor no solo en lo que respecta a los diferentes tipos de complicaciones de la cirugía de cuello sino también a la manera de prevenirlas y, además, los métodos para establecer el diagnóstico correcto y oportuno previo al tratamiento.
Subject(s)
Humans , Male , Female , Neck/surgery , Hemorrhage , Gastrointestinal Hemorrhage , Hypoparathyroidism/etiology , Embolism, Air/diagnosis , Embolism, Air/therapy , Infections , Carotid Sinus , Deglutition Disorders/etiologyABSTRACT
La capnografía se ha mostrado como una valiosa adquisición en el arsenal del anestesista, ya que puede alertarlo sobre situaciones potencialmente mortales, como mala colocación del tubo endotraqueal, desconexión del circuito en un paciente paralizado e hipertermia maligna, condiciones todas que si no sedetectan y tratan precozmente, llevan a un alata morbilidad y posiblemente también mortalidad. El empleo del capnógrafo es útil también en la ventilación artificial, permitiendo en forma individual regular el volumen corriente y volumen minuto utilizando la ETCO2 en lugar de normogramas por kilo de peso. Esto hace que actualmente se pueda efectivamente hablar de ventilación controlada. Esta técnica es de un aprendizaje de la fisiopatología respiratoria aplicada
Subject(s)
Humans , Anesthetics/pharmacology , Carbon Dioxide/pharmacology , Carbon Dioxide/adverse effects , Drug Monitoring , Embolism, Air/diagnosis , Spectrophotometry, Infrared/methods , Blood Gas Monitoring, Transcutaneous/methods , Airway Obstruction/diagnosis , Cardiopulmonary Resuscitation/instrumentationABSTRACT
With the aim of defecting the potential hazard of air embolism, end tidal carbon dioxide (ETCO2) was monitored in 238 patients undergoing neurosurgery (in the sitting position), for early detection of venous air embolism (VAE). Fifty six episodes (26.3%) of significant fall in ETCO2 were observed in 41 patients (17.2%). Haemodynamic disturbances occurred in only 26 patients (10.9%) and were always preceded by a fall in ETCO2. Thirteen patients had positive air aspiration and cardiac murmurs were heard in only six. One patient suffered severe hypoxaemia (PaO2 = 55 mm Hg) whereas two had severe haemodynamic disturbances, but could be promptly resuscitated.